Becoming a Mother after Breast Cancer Treatment

by Evelyn Mok-Lin, MD, and Glenn Schattman, MD

The opportunity to have children, raise a family, and experience the joys of motherhood is a very real prospect for many young women with breast cancer. While there are still thousands of women diagnosed with breast cancer each year, survivors are now living longer and healthier lives thanks in large part to advances in sur­gical and chemotherapy treatments. The American Cancer Society estimates that there are currently over 350,000 young women between the ages of 20 and 39 years old living with cancer in the U.S. Because there are so many reproductive-age cancer survivors who may want children in the future, the topic of fer­tility has become increasingly important to a woman’s treatment, recovery, and healing process.

Dr. Evelyn Mok-Lin

If you had embryos, eggs, or ovarian tissue frozen prior to your cancer treatment and have now been cleared by your oncologist for pregnancy, you may have those cells thawed and trans­ferred back into your body. Frozen embryos have the highest success
rates, with up to a 50-percent chance
of pregnancy per transfer. Frozen eggs – once thawed, fertilized with sperm, and transferred into the uterus as embryos – may also yield comparable pregnancy rates, depending on your age and the number of eggs you were able to have preserved. Embryo or egg freez­ing, while ideally completed prior to chemotherapy, may also be performed successfully soon after treatment, if done prior to significant de­cline in ovarian function. Re­moving and freezing an
entire ovary, followed by subsequent thawing and transplantation of the ovary back into the body, is an experimental technique, but it may be a viable option for prepubertal girls and for women who are unable to undergo an ovarian stimulation cycle.

Dr. Glenn Schattman

If you did not undergo fertility preservation prior to treatment, you still have options. Despite receiving high doses of ovarian-toxic chemo­therapy, many women are still able to conceive a child naturally. The chances of spontaneous pregnancy are highest for younger women who still have
regular, monthly menstrual cycles
after treatment.

If you are unable to conceive on your own, and if adoption is not a viable option for personal or legal reasons, in vitro fertilization (or IVF) is an excel­lent option with success rates that are often comparable to those of women without cancer. Sometimes, ovarian func­tion can be significantly compromised from chemo­therapy such that a woman experiences
early menopause with little to no re­maining ovarian function. In this case, IVF can be performed using eggs do­nated from another woman, which are then fertilized and transferred into your uterus. Because donors are typically young, healthy women in their 20s, pregnancy rates can reach as high as
70 percent.

All of these methods, when approved by your oncologist and performed by an experienced fertility specialist, are considered safe for cancer survivors. Researchers have found that fertility medications and naturally occurring pregnancy hormones do not increase the risk for cancer metastases or recur­rence. In fact, many studies have found that women with a history of breast cancer who had children after treatment had improved survival rates compared to women who did not conceive. Whether this is due to an improvement in quality of life that motherhood can provide is unknown. What most ex­perts can agree upon, however, is that motherhood is a wonderful journey that many breast cancer survivors can now experience because of an increased
emphasis on fertility preservation.

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Dr. Glenn Schattman is an associate professor of obstetrics and gynecology and reproductive medicine at Weill Cornell Medical College in New York, NY, who
specializes in infertility and fertility preserva­tion. Dr. Evelyn Mok-Lin is a board-certified obstetrician/gynecologist completing a
reproductive endocrinology and infertility fellowship at Weill Cornell Medical College.

This article was published in Coping® with Cancer magazine,
May/June
2013.